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Pediatric keratoplasty in India: indications and outcomes
Namrata Sharma1, Gaurav Prakash, Jeewan S Titiyal
1Cornea and Refractive Surgery Services, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Insights
Pediatric corneal transplantation in developing nations is most often needed for infectious keratitis. Graft failure, primarily due to infection, significantly impacts outcomes in these young patients.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Public Health
Background:
- Pediatric corneal transplantation is a critical intervention for vision restoration.
- Developing countries face unique challenges in managing corneal diseases in children.
Purpose of the Study:
- To analyze indications and outcomes of pediatric corneal transplantation.
- To identify factors influencing graft survival and failure in a developing world setting.
Main Methods:
- Retrospective review of 168 pediatric keratoplasty cases over 7 years (1998-2004).
- Analysis of demography, etiology, visual acuity, graft survival, and causes of graft failure.
Main Results:
- Infectious keratitis (43%) was the leading indication for keratoplasty.
- Overall graft survival was 77% at 36 months; younger age and regular follow-up improved outcomes.
- Graft failure occurred in 18.4% of eyes, with graft infection being the most common cause (50%).
Conclusions:
- Infectious keratitis is the primary indication for pediatric keratoplasty in the developing world.
- Graft infection is the most frequent cause of graft failure in pediatric corneal transplants.
Purpose:
To analyze the indications and outcomes of pediatric corneal transplantation surgery in a tertiary eye care center in the developing world.
Methods:
In this longitudinal, retrospective study involving continuous cases, the records of 168 eyes of 154 children undergoing keratoplasty at a tertiary care center's specialized keratoplasty clinic during a 7-year period (1998-2004) were reviewed. The demography, etiology of opacification, visual acuity, and other findings were recorded. Intraoperative and postoperative details were reviewed. Major postoperative outcomes analyzed were visual acuity, graft survival, causes of graft failure, and follow-up duration.
Results:
Infectious keratitis (43%) was the most common indication for keratoplasty, followed by congenital glaucoma (16.6%) and corneal trauma (11.2%). Overall 77% graft survival was seen at 36 months, and better graft outcome was associated with younger age and longer regular follow-up. Postoperatively, a best-corrected visual acuity (BCVA) > 20/200 could be achieved in only 30.1% of eyes at the last follow-up. Graft failure was seen in 18.4% of eyes, with graft infection being the most frequent cause (50%). Moreover, graft infection was the most common cause of graft failure in all age groups.
Conclusions:
In the developing world, infectious keratitis is the most common indication for pediatric keratoplasty and the most frequent cause of its failure.
